Friday, September 25, 2009

A Pre-Mortem on Health Care Reform

I hope that events prove me wrong and that we'll finally have health care reform in this country, but currently I am not sanguine. It seems that health care reform is the Lucy's football of American politics: every so often Democrats or even liberal Republicans (remember them?) will try to kick that football only to have it yanked from under them, so they fall flat on their faces.

This time around, it may be even worse, in fact. The Dems may be so dedicated to actually "doing something" as well as being bipartisan and compromising that they will pass a bill that will actually make things worse: forcing people who can ill afford to buy health care to purchase health care while doing little to prevent health care costs from rising due to increased demand (and decreased demand elasticity) following a health insurance purchase mandate. Of course, in spite of efforts at bipartisanship, no GOoPer will vote for the health care bill and a few Dems. will vote against it -- so the bill will be labeled as "a partisan Dem. bill that was foisted upon us by the left against bipartisan opposition" -- and it will be so used as a cudgel against future progressive reform even if the left doesn't actually like the final bill!

Some Dems. think any health care reform will be good politically? Well not if you are forcing your base to purchase something they can't afford, are proving every GOP fear mongering talking point about progressive "deform" correct and also screwing small business over (with an employer mandate) besides. BTW, while real health care reform will help small businesses because they won't have to struggle to hire people when they can't afford to provide health insurance for employees, an employer mandate will screw over the same people for whom "socialized medicine" is the one bit of "socialism" that has already turned glibertarian small businessfolk into screaming dirty hippies. So quenching a move left amongst main street businessfolk, screwing over young, healthy, underemployed people who are the base of the Dem. party, etc., is good politics?

Of course all of this just points to the underlying problem with true health care reform: it is indeed a giant leap. And Americans, by and large, are a phlegmatic people (our heritage is rooted in the phlegm of England's Hobbits) who don't trust large leaps, unless the leaps involve Empire (e.g. colonizing and killing people of a more dusky hue for fun and profit). Normally our Anglo-American phlegm serves us well -- it keeps us from disastrous changes that could upset our healthy and liberty-full democratic-republican system. But sometimes it hurts us.

In the case of health care reform, dirty hippies like me want us to leap into socialized medicine or at least single payer or (probably better) some German-style hybrid system. But that is too big of a leap for leap-fearing Americans. The problem is that health care reform is a leap across a chasm. So the tendency to simply cut the leap in half will cause us to fall into the chasm of making health care more expensive with mandates, etc.

Indeed, the whole argument for half-way measures is silly: health insurance is expensive because of adverse selection. Ok. But the solution to this is to force young, healthy to buy health insurance they can't afford (otherwise they would likely have bought it by now?)? And if they can't afford it, maybe, just maybe (if the fiscal hawks don't get too penny wise and pound foolish) we'll subsidize them to buy insurance and thus subsidize the health care of sicker folk?

Doesn't that sound a little foolish? Why subsidize people to subsidize insurers to pay for health care? Why not just expand existing social medicine programs to cover more and more people?

Americans are afraid of big leaps. When we do adopt progressive agenda items, it is often because they are targeted to solve specific problems, and Americans love getting things done and solving problems. For example, even if FDR signed onto the Share our Wealth concept, no way he could get it done. Instead he was able to pass an alphabet soup of agencies that addressed specific needs (both to employ people and to deal with deferred infrastructure building). LBJ was not able to get us nationalized health insurance, but he was able to have social medicine that addressed specific needs: e.g. Medicare and Medicaid.

Similarly, if we want socialized medicine, there is no way that leaping into it will work, as the political winds in a country so afraid of leaping (even if a majority of people like the idea of a leap in theory) to anything except Empire building will cause any leap to either be thwarted entirely or turned into a leap half-way across a chasm that will only land us into a pit. What we should do instead is expand the socialized medicine programs we have to address specific shortcomings in our medical system, thus leading on a path toward the nationally socialized system beloved by us dirty hippies.

Evolution man! Not revolution! That's the way to go. Although if you do go for revolution, don't go half-way. If you want to catch or kick a football, you gotta put yourself into the procedure. Otherwise the football will just hit your fingers and toes and break them.